Evaluating Clinical Outcomes in Pregnant Women with Severe Mental Illness: A Retrospective Audit at University Hospitals Birmingham

Abstract

Background: Severe mental illness (SMI) is a leading preventable cause of maternal death in the postpartum period with suicide and psychiatric illness contributing to over one third of deaths between 6 weeks and one year postpartum. The interplay of SMI and pregnancy confers complex clinical demands and a high-risk profile, necessitating early detection and risk stratification and a multi-disciplinary management approach. Objective: This aims to assess the clinical profile, therapeutic approaches and maternal/fetal outcomes of pregnant women with SMI clinically managed at University Hospitals Birmingham (UHB) from July 2021 to July 2024, to informance development of care pathways and strategies to improve the uptake of treatment. Methods: A retrospective review was performed using the electronic maternity record system BadgerNet. All pregnant women with SMI who were booked with UHB during the audit timeframe were included. Data collected included demographics, medication status, gestation or referral age to perinatal mental health (PNMH) services, the use of antipsychotics, obstetric monitoring and postnatal outcomes. Qualitative analyses were based on descriptive statistics of the clinical patterns and service gaps. Results: In a cohort of 1,060 pregnant women with a diagnosis of mental illness, 106 (10%) had evidence of SMI. 71 (67%) were receiving antipsychotics prior to pregnancy, whereas 35 (33%) were either medication-naive or data were unavailable. The audit found discrepancies in monitoring rules:
▪ GTT was performed in 100% of the patients on anti-psychotics.
▪ Growth scans were inconsistently performed.
▪ There was suboptimal Lithium and Lamotrigine monitoring: No patient on Lamotrigine had therapeutic levels monitored (0/4).
▪ There were no patients on Sodium Valproate or Lithium at the time of the audit.
▪ FMU referrals and psychiatric evaluations were infrequently noted.
Conclusion: Pregnant woman with SMI needs close cross disciplinary care, particularly because of the elevated risks of preterm birth, low birth weight and postnatal relapse. The audit highlights the need for preconception counselling, safe pharmacotherapy, antenatal surveillance and comprehensive postnatal planning. Better compliance to the protocol together with earlier introduction of psychiatric care may result in better maternal and neonatal outcomes.